Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens

Background: This study investigated the influence of two conditioning regimens on the chimerical status of 104 patients with acquired severe aplastic anemia. Methods: Patients were monitored for at least 18 months after related bone marrow transplantation and reaching partial or complete hematologic...

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Main Authors: Marcia Quiroga, Noemi Farah Pereira, Marco Antonio Bitencourt, Carmem Bonfim, Marianna Gendre de Mesquita Monteiro, Ricardo Pasquini
Format: Article
Language:English
Published: Elsevier 2018-04-01
Series:Hematology, Transfusion and Cell Therapy
Online Access:http://www.sciencedirect.com/science/article/pii/S2531137918300191
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author Marcia Quiroga
Noemi Farah Pereira
Marco Antonio Bitencourt
Carmem Bonfim
Marianna Gendre de Mesquita Monteiro
Ricardo Pasquini
author_facet Marcia Quiroga
Noemi Farah Pereira
Marco Antonio Bitencourt
Carmem Bonfim
Marianna Gendre de Mesquita Monteiro
Ricardo Pasquini
author_sort Marcia Quiroga
collection DOAJ
description Background: This study investigated the influence of two conditioning regimens on the chimerical status of 104 patients with acquired severe aplastic anemia. Methods: Patients were monitored for at least 18 months after related bone marrow transplantation and reaching partial or complete hematologic recovery. Group I patients (n = 55) received 200 mg/kg cyclophosphamide alone and Group II (n = 49) received 120 mg/kg cyclophosphamide associated with 12 mg/kg busulfan. Patients were classified in three chimerism levels according to the percentage of donor cells in the peripheral blood. Results: Chimerism ≤50% occurred in 36.4% of Group I and none of Group II; chimerism 51–90% was found in 20.0% of Group I and 10.2% of Group II; and chimerism >90% was found in 43.6% of Group I versus 89.8% of Group II. A significant association (p-value < 0.001) was found between conditioning type and chimerism levels. A higher number of infused cells was associated with higher levels of chimerism only in Group I (p-value = 0.013). Multivariate analysis showed that chimerism >90% is associated with the cyclophosphamide plus busulfan conditioning (p-value < 0.001) and higher number of infused cells (p-value = 0.009), suggesting that these factors are predictive of graft outcome. Regarding hematological recovery, higher chimerism levels were associated with higher neutrophil (p-value = 0.003) and platelet counts (p-value < 0.001) in Group I only. These results show that myeloablative conditioning favors full donor chimerism and non-myeloablative conditioning predisposes to mixed chimerism or autologous recovery of hematopoiesis. Conclusion: These data show that autologous recovery depends on the intensity of immunosuppression and that the immunosuppressive function of cyclophosphamide alone can induce this type of hematopoietic recovery. Keywords: Severe aplastic anemia, Bone marrow transplantation, Conditioning regimen, Chimerism
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spelling doaj.art-c7fc2e827b17451bb8d90ca8d485cdb62022-12-21T19:31:33ZengElsevierHematology, Transfusion and Cell Therapy2531-13792018-04-01402112119Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimensMarcia Quiroga0Noemi Farah Pereira1Marco Antonio Bitencourt2Carmem Bonfim3Marianna Gendre de Mesquita Monteiro4Ricardo Pasquini5Corresponding author at: Rua: Emilio Cornelsen, 570 ap. 102, Bloco 6, Ahu, Curitiba, PR, Brazil.; Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, BrazilHospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, BrazilHospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, BrazilHospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, BrazilHospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, BrazilHospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, BrazilBackground: This study investigated the influence of two conditioning regimens on the chimerical status of 104 patients with acquired severe aplastic anemia. Methods: Patients were monitored for at least 18 months after related bone marrow transplantation and reaching partial or complete hematologic recovery. Group I patients (n = 55) received 200 mg/kg cyclophosphamide alone and Group II (n = 49) received 120 mg/kg cyclophosphamide associated with 12 mg/kg busulfan. Patients were classified in three chimerism levels according to the percentage of donor cells in the peripheral blood. Results: Chimerism ≤50% occurred in 36.4% of Group I and none of Group II; chimerism 51–90% was found in 20.0% of Group I and 10.2% of Group II; and chimerism >90% was found in 43.6% of Group I versus 89.8% of Group II. A significant association (p-value < 0.001) was found between conditioning type and chimerism levels. A higher number of infused cells was associated with higher levels of chimerism only in Group I (p-value = 0.013). Multivariate analysis showed that chimerism >90% is associated with the cyclophosphamide plus busulfan conditioning (p-value < 0.001) and higher number of infused cells (p-value = 0.009), suggesting that these factors are predictive of graft outcome. Regarding hematological recovery, higher chimerism levels were associated with higher neutrophil (p-value = 0.003) and platelet counts (p-value < 0.001) in Group I only. These results show that myeloablative conditioning favors full donor chimerism and non-myeloablative conditioning predisposes to mixed chimerism or autologous recovery of hematopoiesis. Conclusion: These data show that autologous recovery depends on the intensity of immunosuppression and that the immunosuppressive function of cyclophosphamide alone can induce this type of hematopoietic recovery. Keywords: Severe aplastic anemia, Bone marrow transplantation, Conditioning regimen, Chimerismhttp://www.sciencedirect.com/science/article/pii/S2531137918300191
spellingShingle Marcia Quiroga
Noemi Farah Pereira
Marco Antonio Bitencourt
Carmem Bonfim
Marianna Gendre de Mesquita Monteiro
Ricardo Pasquini
Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
Hematology, Transfusion and Cell Therapy
title Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
title_full Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
title_fullStr Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
title_full_unstemmed Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
title_short Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
title_sort late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
url http://www.sciencedirect.com/science/article/pii/S2531137918300191
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